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Paramedic

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By Joel D'Eath Canadian Advance Care Paramedic. Interests include advanced airway, sim training, and pre-hospital emergency care.
https://www.readbyqxmd.com/read/28276880/effectiveness-of-prehospital-epinephrine-administration-in-improving-long-term-outcomes-of-witnessed-out-of-hospital-cardiac-arrest-patients-with-initial-non-shockable-rhythms
#1
Jun Tomio, Shinji Nakahara, Hideto Takahashi, Masao Ichikawa, Masamichi Nishida, Naoto Morimura, Tetsuya Sakamoto
OBJECTIVE: We evaluated the association between prehospital epinephrine administration by emergency medical services (EMS) and the long-term outcomes of out-of-hospital cardiac arrest (OHCA) with initial pulseless electrical activity (PEA) or asystole. METHODS: We conducted a controlled, propensity-matched, retrospective cohort study by using Japan's nationwide OHCA registry database. We studied 110,239 bystander-witnessed OHCA patients aged 15-94 years with initial non-shockable rhythms registered between January 2008 and December 2012...
February 7, 2017: Prehospital Emergency Care
https://www.readbyqxmd.com/read/26879087/experts-recommendations-for-the-management-of-cardiogenic-shock-in-children
#2
Olivier Brissaud, Astrid Botte, Gilles Cambonie, Stéphane Dauger, Laure de Saint Blanquat, Philippe Durand, Véronique Gournay, Elodie Guillet, Daniela Laux, Francis Leclerc, Philippe Mauriat, Thierry Boulain, Khaldoun Kuteifan
Cardiogenic shock which corresponds to an acute state of circulatory failure due to impairment of myocardial contractility is a very rare disease in children, even more than in adults. To date, no international recommendations regarding its management in critically ill children are available. An experts' recommendations in adult population have recently been made (Levy et al. Ann Intensive Care 5(1):52, 2015; Levy et al. Ann Intensive Care 5(1):26, 2015). We present herein recommendations for the management of cardiogenic shock in children, developed with the grading of recommendations' assessment, development, and evaluation system by an expert group of the Groupe Francophone de Réanimation et Urgences Pédiatriques (French Group for Pediatric Intensive Care and Emergencies)...
December 2016: Annals of Intensive Care
https://www.readbyqxmd.com/read/28174032/emergency-medicine-myths-epinephrine-in-cardiac-arrest
#3
Brit Long, Alex Koyfman
BACKGROUND: Sudden cardiac arrest accounts for approximately 15% of deaths in developed nations, with poor survival rate. The American Heart Association states that epinephrine is reasonable for patients with cardiac arrest, though the literature behind its use is not strong. OBJECTIVE: To review the evidence behind epinephrine for cardiac arrest. DISCUSSION: Sudden cardiac arrest causes over 450,000 deaths annually in the United States. The American Heart Association recommends epinephrine may be reasonable in patients with cardiac arrest, as part of Advanced Cardiac Life Support...
February 4, 2017: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27852652/chest-compression-fraction-in-ambulance-while-transporting-patients-with-out-of-hospital-cardiac-arrest-to-the-hospital-in-rural-taiwan
#4
Shih-Chang Hung, Ching-Yi Mou, Hung-Chang Hung, I-Hsiang Lin, Shih-Wei Lai, Jack YinChun Huang
INTRODUCTION: Maintaining the standard two-handed chest compression is difficult in high-speed ambulances in rural areas. METHODS: A retrospective, video-based, observational study was conducted from June to September 2013 in Nantou, a rural county of central Taiwan, to evaluate the chest compression fraction in an ambulance carriage during the travel from the scene to the hospital. The chest compression fraction was calculated as the chest compression time period divided by the ambulance travelling time period; the one-handed and two-handed chest compression fractions were also calculated...
November 15, 2016: Emergency Medicine Journal: EMJ
https://www.readbyqxmd.com/read/28193791/epinephrine-for-first-aid-management-of-anaphylaxis
#5
Scott H Sicherer, F Estelle R Simons
Anaphylaxis is a severe, generalized allergic or hypersensitivity reaction that is rapid in onset and may cause death. Epinephrine (adrenaline) can be life-saving when administered as rapidly as possible once anaphylaxis is recognized. This clinical report from the American Academy of Pediatrics is an update of the 2007 clinical report on this topic. It provides information to help clinicians identify patients at risk of anaphylaxis and new information about epinephrine and epinephrine autoinjectors (EAs). The report also highlights the importance of patient and family education about the recognition and management of anaphylaxis in the community...
March 2017: Pediatrics
https://www.readbyqxmd.com/read/25642320/review-of-naloxone-safety-for-opioid-overdose-practical-considerations-for-new-technology-and-expanded-public-access
#6
REVIEW
Daniel P Wermeling
Opioid overdose and mortality have increased at an alarming rate prompting new public health initiatives to reduce drug poisoning. One initiative is to expand access to the opioid antidote naloxone. Naloxone has a long history of safe and effective use by organized healthcare systems and providers in the treatment of opioid overdose by paramedics/emergency medicine technicians, emergency medicine physicians and anesthesiologists. The safety of naloxone in a prehospital setting administered by nonhealthcare professionals has not been formally established but will likely parallel medically supervised experiences...
February 2015: Therapeutic Advances in Drug Safety
https://www.readbyqxmd.com/read/26958801/the-profile-of-wounding-in-civilian-public-mass-shooting-fatalities
#7
Edward Reed Smith, Geoff Shapiro, Babak Sarani
BACKGROUND: The incidence and severity of civilian public mass shootings (CPMS) continue to rise. Initiatives predicated on lessons learned from military woundings have placed strong emphasis on hemorrhage control, especially via use of tourniquets, as means to improve survival. We hypothesize that both the overall wounding pattern and the specific fatal wounds in CPMS events are different from those in military combat fatalities and thus may require a new management strategy. METHODS: A retrospective study of autopsy reports for all victims involved in 12 CPMS events was performed...
July 2016: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/27506448/sexual-assault-what-every-emergency-provider-needs-to-know
#8
Rebecca Barron, Elena Kapilevich, Susan Duffy, Alyson J McGregor
No abstract text is available yet for this article.
October 2016: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/27478148/cpr-induced-consciousness-a-cross-sectional-study-of-healthcare-practitioners-experience
#9
Alexander Olaussen, Matthew Shepherd, Ziad Nehme, Karen Smith, Paul A Jennings, Stephen Bernard, Biswadev Mitra
INTRODUCTION: Consciousness may occur during effective management of cardiac arrest and ranges from eye opening to interfering with rescuers' resuscitation attempts. Reported cases in the medical literature appear scant compared to anecdotal reports. The aim of this study was to evaluate health care providers' experience with consciousness during cardio-pulmonary resuscitation (CPR). METHODS: A cross-sectional survey of 100 experienced health care professionals, including doctors, nurses and paramedics...
November 2016: Australasian Emergency Nursing Journal: AENJ
https://www.readbyqxmd.com/read/27411984/a-population-based-study-of-drowning-in-canada
#10
Tessa Clemens, Hala Tamim, Michael Rotondi, Alison K Macpherson
BACKGROUND: Although water-related fatality rates have changed over time, the epidemiology of drowning in Canada has not recently been examined. In spite of the evidence supporting varying drowning death rates by age, information on how characteristics of drowning incidents differ by age group remains limited. The primary objective of this study was to examine the epidemiology of drowning in Canada. A secondary objective was to describe the characteristics of these drowning incidents as they vary by age group...
July 13, 2016: BMC Public Health
https://www.readbyqxmd.com/read/26680137/prehospital-interventions-in-severely-injured-pediatric-patients-rethinking-the-abcs
#11
Kyle K Sokol, George E Black, Kenneth S Azarow, William Long, Matthew J Martin, Matthew J Eckert
BACKGROUND: The current conflict in Afghanistan has resulted in a high volume of significantly injured pediatric patients. The austere environment has demanded emphasis on prehospital interventions (PHIs) to sustain casualties during transport. METHODS: The Department of Defense Trauma Registry was queried for all pediatric patients (≤18 years) treated at Camp Bastion from 2004 to 2012. PHIs were grouped by Advanced Trauma Life Support categories into (1) airway (A)--intubation or surgical airway; 2) breathing (B)--chest tube or needle thoracostomy; and 3) circulation (C)--tourniquet or hemostatic dressing...
December 2015: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/27342573/mechanical-circulatory-assist-devices-a-primer-for-critical-care-and-emergency-physicians
#12
REVIEW
Ayan Sen, Joel S Larson, Kianoush B Kashani, Stacy L Libricz, Bhavesh M Patel, Pramod K Guru, Cory M Alwardt, Octavio Pajaro, J Christopher Farmer
Mechanical circulatory assist devices are now commonly used in the treatment of severe heart failure as bridges to cardiac transplant, as destination therapy for patients who are not transplant candidates, and as bridges to recovery and "decision-making". These devices, which can be used to support the left or right ventricles or both, restore circulation to the tissues, thereby improving organ function. Left ventricular assist devices (LVADs) are the most common support devices. To care for patients with these devices, health care providers in emergency departments (EDs) and intensive care units (ICUs) need to understand the physiology of the devices, the vocabulary of mechanical support, the types of complications patients may have, diagnostic techniques, and decision-making regarding treatment...
June 25, 2016: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/26496112/redefining-dead-on-arrival-identifying-the-unsalvageable-patient-for-the-purpose-of-performance-improvement
#13
James P Byrne, Wei Xiong, David Gomez, Stephanie Mason, Paul Karanicolas, Sandro Rizoli, Homer Tien, Avery B Nathens
BACKGROUND: Significant variation exists across registries in the criteria used to identify patients with no chance of survival, with potential for profound impact on trauma center mortality. The purpose of this study was to identify the optimal case definition for the unsalvageable patient, for the purpose of exclusion from performance improvement (PI) endeavors. METHODS: Data were derived from the American College of Surgeons' Trauma Quality Improvement Program for 2012 to 2013...
November 2015: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/27352210/prehospital-factors-associated-with-an-acute-life-threatening-condition-in-non-traumatic-chest-pain-patients-a-systematic-review
#14
REVIEW
Kristoffer Wibring, Johan Herlitz, Lennart Christensson, Markus Lingman, Angela Bång
BACKGROUND: Chest pain is a common symptom among patients contacting the emergency medical services (EMS). Risk stratification of these patients is warranted before arrival in hospital, regarding likelihood of an acute life-threatening condition (LTC). AIM: To identify factors associated with an increased risk of acute LTC among patients who call the EMS due to non-traumatic chest pain. METHODS: Several databases were searched for relevant articles...
September 15, 2016: International Journal of Cardiology
https://www.readbyqxmd.com/read/27344928/dual-defibrillation-in-out-of-hospital-cardiac-arrest-a-retrospective-cohort-analysis
#15
Elliot M Ross, Theodore T Redman, Stephen A Harper, Julian G Mapp, David A Wampler, David A Miramontes
STUDY OBJECTIVES: The goal of our study is to determine if prehospital dual defibrillation (DD) is associated with better neurologically intact survival in out-of-hospital cardiac arrest. METHODS: This study is a retrospective cohort analysis of prospectively collected Quality Assurance/Quality Improvement data from a large urban fire based EMS system out-of-hospital cardiac arrest (OHCA) database between Jan 2013 and Dec 2015. Our inclusion criteria were administration of DD or at least four conventional 200J defibrillations for cases of recurrent and refractory ventricular fibrillation (VF)...
September 2016: Resuscitation
https://www.readbyqxmd.com/read/27225648/reactions-and-coping-strategies-in-lay-rescuers-who-have-provided-cpr-to-out-of-hospital-cardiac-arrest-victims-a-qualitative-study
#16
Wenche Torunn Mathiesen, Conrad Arnfinn Bjørshol, Geir Sverre Braut, Eldar Søreide
OBJECTIVE: Cardiopulmonary resuscitation (CPR) provided by community citizens is of paramount importance for out-of-hospital cardiac arrest (OHCA) victims' survival. Fortunately, CPR rates by community citizens seem to be rising. However, the experience of providing CPR is rarely investigated. The aim of this study was to explore reactions and coping strategies in lay rescuers who have provided CPR to OHCA victims. METHODS, PARTICIPANTS: This is a qualitative study of 20 lay rescuers who have provided CPR to 18 OHCA victims...
2016: BMJ Open
https://www.readbyqxmd.com/read/27211834/impact-brain-apnoea-a-forgotten-cause-of-cardiovascular-collapse-in-trauma
#17
REVIEW
Mark H Wilson, John Hinds, Gareth Grier, Brian Burns, Simon Carley, Gareth Davies
OBJECTIVE: Early death following cranial trauma is often considered unsurvivable traumatic brain injury (TBI). However, Impact Brain Apnoea (IBA), the phenomenon of apnoea following TBI, may be a significant and preventable contributor to death attributed to primary injury. This paper reviews the history of IBA, cites case examples and reports a survey of emergency responder experience. METHODS: Literature and narrative review and focused survey of pre-hospital physicians...
August 2016: Resuscitation
https://www.readbyqxmd.com/read/27043165/amiodarone-lidocaine-or-placebo-in-out-of-hospital-cardiac-arrest
#18
RANDOMIZED CONTROLLED TRIAL
Peter J Kudenchuk, Siobhan P Brown, Mohamud Daya, Thomas Rea, Graham Nichol, Laurie J Morrison, Brian Leroux, Christian Vaillancourt, Lynn Wittwer, Clifton W Callaway, James Christenson, Debra Egan, Joseph P Ornato, Myron L Weisfeldt, Ian G Stiell, Ahamed H Idris, Tom P Aufderheide, James V Dunford, M Riccardo Colella, Gary M Vilke, Ashley M Brienza, Patrice Desvigne-Nickens, Pamela C Gray, Randal Gray, Norman Seals, Ron Straight, Paul Dorian
BACKGROUND: Antiarrhythmic drugs are used commonly in out-of-hospital cardiac arrest for shock-refractory ventricular fibrillation or pulseless ventricular tachycardia, but without proven survival benefit. METHODS: In this randomized, double-blind trial, we compared parenteral amiodarone, lidocaine, and saline placebo, along with standard care, in adults who had nontraumatic out-of-hospital cardiac arrest, shock-refractory ventricular fibrillation or pulseless ventricular tachycardia after at least one shock, and vascular access...
May 5, 2016: New England Journal of Medicine
https://www.readbyqxmd.com/read/26897074/could-ten-questions-asked-by-the-dispatch-center-predict-the-outcome-for-patients-with-chest-discomfort
#19
Nina Rawshani, Araz Rawshani, Carita Gelang, Johan Herlitz, Angela Bång, Jan-Otto Andersson, Martin Gellerstedt
BACKGROUND AND AIMS: From 2009 to 2010, approximately 14,000 consecutive persons who called for the EMS due to chest discomfort were registered. From the seventh month, dispatchers ask 2285 patient ten pre-specified questions. We evaluate which of these questions was independently able to predict an acute coronary syndrome (ACS), life-threatening condition (LTC) and death. METHODS: The questions asked mainly dealt with previous history and type of symptoms, each with yes/no answers...
April 15, 2016: International Journal of Cardiology
https://www.readbyqxmd.com/read/26951821/sudden-cardiac-death-in-the-young
#20
REVIEW
Michael Ackerman, Dianne L Atkins, John K Triedman
Although the occurrence of sudden cardiac death (SCD) in a young person is a rare event, it is traumatic and often widely publicized. In recent years, SCD in this population has been increasingly seen as a public health and safety issue. This review presents current knowledge relevant to the epidemiology of SCD and to strategies for prevention, resuscitation, and identification of those at greatest risk. Areas of active research and controversy include the development of best practices in screening, risk stratification approaches and postmortem evaluation, and identification of modifiable barriers to providing better outcomes after resuscitation of young SCD patients...
March 8, 2016: Circulation
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